THE EFFECT OF PREOPERATIVE FASTING PERIOD ON RENAL ISCHEMIA REPERFUSION INJURY IN RATS

Mustafa Cem Yilmaz^{1, *}, Ezgi Erkilic², Ersin Gurkan Dumlu³, Ebru Menekse³, Nermin Göğüş², Yasemin Akcaalan², Betul Ogut⁴, Aylin Sepici Dincel⁵ 

¹Ankara Kahramankazan State Hospital, Anesthesia and Reanimation Department - ²Ankara City Hospital, Anesthesia and Reanimation Department - ³Ankara Yıldırım Beyazıt University, General Surgery Department - ⁴Ankara Gazi University Medicine Faculty, Pathology Department - ⁵Ankara Gazi University Medicine Faculty, Biochemistry Department

Introduction: Preoperative fasting is a traditional method used to avoid pulmonary aspiration and related complications. However, with the enhanced recover after surgery (ERAS) protocols, preoperative fasting periods have started to decrease. Ischemia reperfusion injury (IRI) has an important place in the etiology of acute kidney injury. We aimed to observe the effect of preoperative short fasting periods on renal IRI.

Materials and Methods: 21 wistar albino rats were included in the study. Rats were randomized as sham A group fasted for 12 hours preoperatively, group B fasted for 12 hours preoperatively, group C for 2 hours preoperatively. Firstly blood samples were taken for neutrophil gelatinase-associated lipocalin and interlukin-6. After laparotomy, in groups B and C, renal ischemia applied by clamping left renal pedicle 20 min. Then 20 minutes reperfusion was allowed. After then left and right nephrectomy was performed. After blood samples were taken to postoperative values, rats were sacrificed.

Results: In the histopathological examination, proximal tubular epithelium brush-border loss, apoptosis and tubular cast formation were examined. For apoptosis, the score was significantly higher in the left kidney with ischemia in group B compared to the right kidney (p=0.008). In tubular cast formation scores, statistically significant increases were observed for both right and left kidneys in group B (p=0.015, p=0.017). 

Conclusion: In our study, we found that the preoperative short fasting period in rats has a positive effect in the case of mild renal ischemia reperfusion injury. However, we think that many more studies should be done on this subject.